International Circulation: What is your opinion on bifurcation lesion treatment? Do you prefer to perform any special strategy? Would you like to give us some tips?
《国际循环》：您认为如何处理分叉病变？您本人更倾向于哪种治疗策略？可以给我们些建议吗？

Prof. Saito: I think that we have different kinds of techniques like simple stenting， T-Stenting， provisional T-stenting， crush stenting， and Y-stenting. However， I think that which strategy we have to take depends on the anatomy of the lesion. Especially for left main bifurcation lesions， IVUS examination is quite important to fix a strategy.
Satio教授：简单支架、T支架、必要时T支架、挤压支架和Y支架等方法均是不同的处理技术。但是，具体采用哪种方法应该取决于病变的解剖位置。特别是对于左冠状动脉主支分叉处的病变，血管内超声检查对确定使用哪种方法是非常重要的。

International Circulation: With the development of PCI devices and improvement of PCI technology， more CTO patients have received benefits from PCI. However， there is still a big challenge to treat CTO for most of doctors. Would you like to share the key points of CTO treatment with us? How to select appropriate cases? What is the most important factor in a PCI procedure? Do you have any tip for choosing guide wires?
《国际循环》：随着介入器械和技术的进展，许多慢性闭塞病变患者可以从PCI术中获益，但是，对于大多数医生来说，CTO病变的处理依然是极大的挑战。您是否愿意与我们分享您在CTO治疗方面的经验？如何选择病例？PCI过程中最重要的因素是什么？您在导丝的选择方面有什么技巧？

Prof. Saito: There are many tips. The majority of those techniques were developed by Japanese physicians. The most important thing is that we have to have very good diagnostic angiography. That is very important. I visit many countries and I am asked to do CTO angioplasty and in those countries many times I see the diagnostic angiography is not very good. You have to take the long shot. By taking the long shot you can see the collateral circulation very nicely. Also， to see the collateral route， we always take the cranial and caudal but in the majority of cath labs they never take these kinds of projections. It’s very important because very often we are taking a retrograde approach crossing the collateral circulation.

For the choice of guidewires we have many kinds of guidewires developed in Japan. In China， I think only the wires from Asahi are available so there is a limited selection.

I am a radiologist and I do not like the transfemoral approach but for CTO I recommend the transfemoral approach. I also recommend that you take bilateral simultaneous angiography to look at the distal anatomy. This is very important.

Satio教授：是有很多可以跟大家分享的技巧。大部分治疗方法是由日本的临床医生发明的。最重要的是我们需要具备很好的诊断性血管造影技术。这是非常重要的。我访问过很多国家，受那些国家的邀请进行过CTO血管成形术，发现他们的诊断性血管造影技术不是很好。必须使用长镜头。使用长镜头可以很好的观察侧支循环的情况。同时，为了观察侧支循环情况，我们通常使用经颅和经骶途径观察，但是大部分导管室都没有采用这类的检查。这是非常重要的，因为我们通常采取倒退的方法跨过侧支循环。

对于导丝的选择，日本有许多种导丝。在中国，我认为选择有限，只有Asahi导丝可供使用。

我是一位放射科医生，我不喜欢经股方法，但对CTO患者我推荐使用经股通路。我同时推荐使用双侧血管造影观察远端的解剖情况。这是非常重要的。

International Circulation: Your topic at CIT 2009 is “Introduction and Setting Up the Catheter Laboratories for CTO: What Kinds of Devices to Be Prepared， Diagnostic Imaging”. Can you talk about some of the difficulties， issues， or important factors to be considered when setting up a catheter lab for CTO?
《国际循环》：您在2009年CIT的报告题目为“建立CTO的导管室及介绍：需要准备哪种诊断性影响学的设备”。您能介绍一下关于这项工作的困难、会遇到的问题或是在建立CTO导管室时的重要因素吗？

Prof. Saito: I am always talking about how simultaneous bilateral angiography is very important. Very often in foreign countries in many cath labs they don’t have dual pressure monitors. So how can we take bilateral angiography? So， first of all， they have to prepare double pressure lines and they have to prepare metal sheaths to straighten very tortuous arteries. These two things are the minimum requirements. You also have to prepare enough different types of shapes for guiding catheters. Of course， you have to prepare for an 8 French system. The next step would be you would have to prepare different kinds of wires.
Satio教授：我经常讲同时进行双侧血管造影是非常重要的。在国外很多导管室，不进行双侧压力的监测。那么我们应该如何进行双侧血管造影呢？首先我们应该具备双测压系统，有金属鞘可以将非常弯曲的动脉变直。这两项是至少要具备的。还应该准备足够的不同形状类型的导引管。当然，也必须有8 French系统。下一步是要准备不同类型的导丝。